Artesunate for the Treatment of Severe Falciparum Malaria

Abstract

A previously well, American-born 35-year-old man presents with a 5-day history of fever and progressive dyspnea and a 2-day history of jaundice. An evaluation 3 days before his presentation led to a diagnosis of a viral syndrome. The patient had re-turned 3 weeks earlier from a 1-month stay in West Africa. He reports receiving im-munizations before travel and taking pills to prevent malaria weekly until his return to the United States. The physical examination shows moderate respiratory distress, diffuse pulmo-nary crackles, and mild jaundice. His vital signs include a temperature of 39.8°C, respiratory rate of 32 breaths per minute, and oxygen saturation of 87% while he is breathing ambient air. Abnormal results of laboratory tests include a hematocrit of 32.2%, platelet count of 78 per cubic millimeter, total bilirubin level of 4.2 mg per deciliter (71.8 μmol per liter), and creatinine level of 2.2 mg per deciliter (194.5 μmol per liter). A Giemsa-stained blood smear shows numerous ring forms of Plasmodium falciparum, with parasitemia estimated at 2%. He is immediately hospitalized, and an infectious-disease consultant recommends that the Centers for Disease Control and Prevention (CDC) be contacted to obtain intravenous artesunate for his treatment.